Long term follow up of biomarkers of podocyte damage and renal function in patients with and without preeclampsia.

INTRODUCTION: preeclampsia can be associated with future renal disease. OBJECTIVES: To measure changes in renal function overtime in patients with preeclampsia. METHODS: urine and serum samples from eleven patients with preeclampsia and eight patients with a normal pregnancy were obtained during pregnancy, postpartum, and 3 years after delivery. Urine podocalyxin, protein, and serum creatinine were measured. RESULTS: after 3 years, there were no significant differences in urinary podocalyxin in patients with or without preeclampsia: 4.34 ng/mg [2.69, 8.99] vs. 7.66 ng/mg [2.35, 13], p = 0.77. The same applied to urinary protein excretion: 81.5 mg/g [60.6, 105.5] vs. 43.2 mg/g [20.9, 139.3] p = 0.23. Serum creatinine was 0.86 mg/dL [0.7, 0.9] vs. 0.8 mg/dL [0.68, 1] p = 0.74 in those with and without preeclampsia. In normal patients, urinary podocalyxin decreased from 54.4 ng/mg [34.2, 76.9] during pregnancy to 7.66 ng/mg [2.35, 13] three years after pregnancy, p = 0.01. Proteinuria decreased from 123.5 mg/g [65.9, 194.8] to 43.2 mg/g [20.9, 139.3], p = 0.12. In preeclampsia patients, urinary podocalyxin decreased from 97.5 ng/mg [64.9, 318.4] during pregnancy to 37.1 ng/mg within one week post-partum [21.3, 100.4] p = 0.05 and 4.34 ng/mg [2.69, 8.99] three years after, p = 0.003. Proteinuria was 757.2 mg/g [268.4, 5031.7] during pregnancy vs. 757.2 mg/g [288.2, 2917] postpartum, p = 0.09 vs. 81.5 mg/g [60.6, 105.5] three years later, p = 0.01. Two patients still had proteinuria after 3 years. CONCLUSIONS: in preeclampsia patients, postpartum urinary podocalyxin decreased before proteinuria. After three years, serum creatinine, urinary podocalyxin, and protein tended to normalize, although some patients still had proteinuria.

Urinary podocalyxin as a marker of preeclampsia in a Hispanic population.

BACKGROUND: Preeclampsia is associated with significant materno-fetal morbidity and mortality. Podocyturia due to podocyte damage seems to be associated with the disease. The objective of this study was to evaluate the usefulness of urinary podocalyxin as a marker of preeclampsia in a Hispanic population. METHODS: 63 patients were studied. 25 patients had preeclampsia/eclampsia (PE-E). 38 patients had normal pregnancies and served as control group. 24 hour proteinuria, urine protein/creatinine (UPC), urinary podocalyxin and perinatal outcomes were measured. A Podocalyxin ELISA test was used to detect podocyturia. RESULTS: Mean age (years), mean±SD was 30.5±5.4 in normal patients vs 30.6±5.8 in PE-E, p=0.98. Median gestational age (weeks) was, 38 (range 21-42) for normal pregnancies and 36 (range 24-40) for patients with PE-E, <0.001. Urine podocalyxin/creatinine on admission (ng/mg), median [IQR] in normal patients was 55.9 [29.4, 74.9] vs 109.7 [63.8, 234.1] in PE-E, p=0.001. After adjusting for admission proteinuria, urinary podocalyxin remained independently associated with preeclampsia: OR=1.0040 (95% CI 1.0003-1.0078), p=0.03. There was low to moderate correlation between UPC and urinary podocalyxin, Spearman's =0.31, p=0.01. In PE-E, post-partum urine podocalyxin was lower, median [IQR]: 69.7 [32.7, 184.8] p=0.19 vs admission. There was a trend towards more podocyturia and proteinuria in patients with eclampsia, comparing to those with preeclampsia. There was no association observed between podocyturia and neonatal mortality, IUGR or Apgar scores. CONCLUSIONS: Significantly higher levels of urinary podocalyxin are seen in preeclampsia/eclampsia. They tend to normalize after delivery.

Alta frecuencia de infección urinaria en el embarazo: un estudio de 100 pacientes. Artículos originales / High frequency of urinary infection in the pregnancy: 100 patients study. Original articles

Objetivos: determinar la frecuencia de infección urinaria en un grupo de pacientes que acuden a la consulta prenatal, e identificar los gérmenes más frecuentes, y su sensibilidad a los antibióticos más comúnmente utilizados en obstetricia. Materiales y métodos: Constituyen un estudio prospectivo laboratorial de corte transversal, realizado en el período de enero-febrero de 2001 en el laboratorio de la Cátedra de Microbiología de la Facultad de Ciencias Médicas-UNA. Se recolectaron muestras de orina en forma aséptica, a 100 embarazadas de 16 a 40 semanas de gestación, practicándose en ellas el estudio del sedimento, urocultivo y antibiograma. Resultados: De un total de 100 pacientes, se obtuvieron 22 por ciento de urocultivos positivos, de los cuales el 77,2 por ciento correspondió a bacteriuria asintomática, 18,2 por ciento a cistitis y el 4,5 por ciento a pielonefritis. El 22,6 por ciento de estas pacientes, presentó contracciones prematuras. De los gérmenes aislados 91 por ciento fueron bacterias gram negativas, de entre ellas: Escherichia coli 65 por ciento (13 urocultivos), Klebsiella pneumoniae 15 por ciento (3 urocultivos), Acinetobacter 10 por ciento (2 urocultivos), Kl. oxytoca 5 por ciento (1 urocultivos), Enterobacter aerogenes 5 por ciento (1 urocultivo); el 9 por ciento restante (2 urocultivos) fueron bacterias gram positivas; Staphylococcus aureus y Enterococcus faecalis. El 100 por ciento de las cepas de E. coli presentó resistencia a la ampicilina, y fue sensible a la norfloxacina; en cuanto a la Klebsiella pneumoniae el 100 por ciento fue sensible a la nitrofurantoina, norfloxacina y cefuroxima, el 66,7 por ciento fue resistente a gentamicina. Discusión: La elevada frecuencia de infección urinaria en el grupo de pacientes estudiados, los tipos de gérmenes aislados y la asociación con amenaza de parto prematuro concuerdan con la bibliografía consultada. La resistencia a la ampicilina encontrada, podría constituir un serio inconveniente en el momento de iniciar el tratamiento, ya que la administración de antibióticos está restringida durante el embarazo, siendo la ampicilina uno de los pocos que se pueden utilizar con cierta libertad durante el mismo y que además ofrece la ventaja de su realtivo bajo costo...